Discussion of public health and health care policy, from a public health perspective. The U.S. spends more on medical services than any other country, but we get less for it. Major reasons include lack of universal access, unequal treatment, and underinvestment in public health and social welfare. We will critically examine the economics, politics and sociology of health and illness in the U.S. and the world.

Tuesday, April 30, 2019

My alma mater has suspended fraternity activity because of some leaked documents that show members of one -- Phi Psi -- celebrating blackout drinking and insulting women, racial and gender minorities and joking about sexual assault. Coincidentally, I had lunch with my mother on Sunday, who is also an alum, and we talked about Swarthmore College fraternities. There are only two, and there are no sororities.

When I was there, I had friends who were members of the other frat, Delta Upsilon, and I went to some parties there -- I got invited because I was on the wrestling team -- but I had no interest in membership. DU was actually the rowdier frat in those days. They'd fill a washtub with grain alcohol punch, have contests for longest continuous sucking beer from the keg, and of course smoke mass quantities of pot. I wasn't privy to their meetings or internal doings, so I don't know about the rest of it. I did have a woman friend who wanted to go to a party there and asked me to escort her for protection, so she must have been worried about something, but I had other female friends at those parties and they seemed to be having a good time. That's all I really know.

It seems to be generally hazardous for young men to form secret societies and carry on as they will. Our gender role norms, combined with hormones and underdeveloped frontal cortices, are a toxic brew. I think it's great for there to be student clubs and organizations, but they need to have some purpose other than swallowing ethanol and competing to for the title of worst pig. As far as I can tell most of fraternities exist basically for those purposes. I think a rule that sanctioned student organizations ought to have open membership, or objective and defensible membership criteria; admit all genders; and have a degree of transparency is right for every college and university.

Monday, April 29, 2019

Folks at the WaPo apparently have plenty of time on their hands, because they've been keeping track of the lies of the Resident. They have so far tallied 10,000 since he took office, so the turning over of the odometer has occasioned an announcement. The torrent of lies has accelerated, from 601 days to get to 5,000 to 226 to get to 10,000.

That's pretty damn weird. He repeats his lies dozens of times even after they have been thoroughly debunked. Truth is not just irrelevant, it seems not to exist. It isn't even a category. Okay, that's disturbing but it's even more disturbing to see the contortions the corporate media, including the major news networks and the New York Times go through to avoid using the word "lie" to describe what are in fact lies. Even the WaPo, when they aren't specifically writing a story about his pathological lying, generally avoids the word. And of course the Republicans in congress are just fine with it.

Mitt Romney lied constantly as well, during his presidential campaign, and the corporate media wouldn't impose any consequences. Fortunately he didn't become president, and he seems to have toned down the prevarication as a senator, but basically, there is no penalty for politicians lying. We cannot have a functional republic while this is happening.

Update:And here's more commentary from Aaron Rupar. It's not just the quantity of lies, it's also the outrageousness of the lies. The allergy the corporate media have to the word "lie" when it comes to this malignant lunatic is just inexplicable -- particularly because he is demonizing them along with his other perceived enemies. They seem to be gluttons for punishment.

And in other news, sure, he's not the only politician who ever lied but this is not in the same category, or even in the same universe.

Update 2: Why do I have to keep saying this. You may not post as "unknown." Choose a handle.

Sunday, April 28, 2019

Exodus 3 is one of the most famous passages in the Bible. By famous I mean that people have some images from it in their heads, particularly the burning bush and the declaration "I am who I am" (KJV "I am that I am). I don't mean that very many people have actually read it and thought about it. So let's give it a good look.

Now Moses was tending the flock of Jethro his father-in-law, the priest of Midian, and he led the flock to the far side of the wilderness and came to Horeb, the mountain of God.2 There the angel of the Lord appeared to him in flames of fire from within a bush. Moses saw that though the bush was on fire it did not burn up.3 So Moses thought, “I will go over and see this strange sight—why the bush does not burn up.”4 When the Lord saw that he had gone over to look, God called to him from within the bush, “Moses! Moses!”And Moses said, “Here I am.”

God has appeared to people, and spoken to them, in various ways. Often it's unspecified: "God said," or "God told him," and we don't know how this happened. Maybe the person just heard a voice inside his head, or maybe the words came down from the sky. Who knows? But God interacted with Adam and Eve physically, in the guise of a human who visited them and talked to them. God also "appeared" to Abraham on several occasions but we aren't told what he looked like, with the exception of one occasion in which he appeared as a human, along with two angels in the same guise, who also hung out with Lot. God also "appeared" to Isaac a couple of times, and of course Jacob actually beat God in a wrestling match. "Thy name shall be called no more Jacob, but Israel: for as a prince hast thou
power with God and with men, and hast prevailed. And Jacob called the name of the place Peniel:
for I have seen God face to face, and my life is preserved." (Genesis 32:30) God will be seen by various characters later in the book, but this device of the burning bush is unique. The question is why God found it necessary since he's never before been averse to just showing up.

5 “Do not come any closer,” God said. “Take off your sandals, for the place where you are standing is holy ground.”6 Then he said, “I am the God of your father,[a] the God of Abraham, the God of Isaac and the God of Jacob.” At this, Moses hid his face, because he was afraid to look at God.7 The Lord said, “I have indeed seen the misery of my people in Egypt. I have heard them crying out because of their slave drivers, and I am concerned about their suffering.8 So I have come down to rescue them from the hand of the Egyptians and to bring them up out of that land into a good and spacious land, a land flowing with milk and honey—the home of the Canaanites, Hittites, Amorites, Perizzites, Hivites and Jebusites.9 And now the cry of the Israelites has reached me, and I have seen the way the Egyptians are oppressing them.10 So now, go. I am sending you to Pharaoh to bring my people the Israelites out of Egypt.”

Okay, so God apparently hadn't been paying attention. Now he's suddenly noticed what's going on and he proposes to do something about it. Specifically, he's going to get them out of Egypt and let them take land away from other people. But you know, he's God almighty. He doesn't have to resort to these elaborate stratagems. And of course he set this whole thing up on purpose in the first place.

11 But Moses said to God, “Who am I that I should go to Pharaoh and bring the Israelites out of Egypt?”12 And God said, “I will be with you. And this will be the sign to you that it is I who have sent you: When you have brought the people out of Egypt, you[b] will worship God on this mountain.”13 Moses
said to God, “Suppose I go to the Israelites and say to them, ‘The God
of your fathers has sent me to you,’ and they ask me, ‘What is his
name?’ Then what shall I tell them?”14 God said to Moses, “I am who I am.[c] This is what you are to say to the Israelites: ‘I am has sent me to you.’”

This is extremely odd. They know perfectly well the name of the God of their fathers. It's a little bit complicated but he is referred to as Elohim, which is the generic word for God; and as YHWH, which is generally pronounced either as Jehovah or Yahweh by those who pronounce it. Orthodox Jews do not. There are no vowels because Biblical Hebrew doesn't have any for any words, it isn't something special about this particular name. But orthodox Jews keep up the convention even when they are speaking English, and write G_D. Since they aren't allowed to pronounce God's name, they will substitute "Adonai," "the Lord" when they come across YHWH in a biblical passage. Adonai Eloheinu, a familiar phrase, means "Lord our God." As you will see in the very next verse, this works perfectly well, so it's a mystery why we also need to call him "I am."

15 God also said to Moses, “Say to the Israelites, ‘The Lord,[d] the God of your fathers—the God of Abraham, the God of Isaac and the God of Jacob—has sent me to you.’

“This is my name forever,the name you shall call mefrom generation to generation.

I'm afraid I don't have the Hebrew but I presume this is translating Adonai (the Lord) and Eloim, God.

16 “Go, assemble the elders of Israel and say to them, ‘The Lord, the God of your fathers—the God of Abraham, Isaac and Jacob—appeared to me and said: I have watched over you and have seen what has been done to you in Egypt.17 And I have promised to bring you up out of your misery in Egypt into the land of the Canaanites, Hittites, Amorites, Perizzites, Hivites and Jebusites—a land flowing with milk and honey.’

Again, the tendency for redundancy. I suspect this is because it is assumed most consumers will be illiterate and will hear this read or recited.

18 “The elders of Israel will listen to you. Then you and the elders are to go to the king of Egypt and say to him, ‘The Lord, the God of the Hebrews, has met with us. Let us take a three-day journey into the wilderness to offer sacrifices to the Lord our God.’19 But I know that the king of Egypt will not let you go unless a mighty hand compels him.20 So I will stretch out my hand and strike the Egyptians with all the wonders that I will perform among them. After that, he will let you go.

Of course, he's God almighty. He could probably get the king's cooperation by less drastic means. We'll have to confront that moral problem shortly.

21 “And I will make the Egyptians favorably disposed toward this people, so that when you leave you will not go empty-handed.22 Every woman is to ask her neighbor and any woman living in her house for articles of silver and gold and for clothing, which you will put on your sons and daughters. And so you will plunder the Egyptians.”

This is quite weird. The Hebrews are slaves, right? But the Egyptian women are going to hand over all their finery when asked? If God can make them do that, he can make the king let the Hebrews go, without all the sturm und drang, right? Well, he works in mysterious ways.

Friday, April 26, 2019

It looks like I'll have to put this in the sidebar, but anonymous comments are not permitted, no matter how wise or appropriate. That includes adopting "anonymous" or "unknown" as a handle. Commenters must choose a distinct name -- it can be your real name or a pseudonym -- and use it consistently. There are good reasons for this rule.

[A] at a time when civilization is
accelerating toward disaster, climate silence continues to reign across
the bulk of the US news media. Especially on television, where most
Americans still get their news, the brutal demands of ratings and money
work against adequate coverage of the biggest story of our time. Many
newspapers, too, are failing the climate test. Last October, the
scientists of the United Nations’ Intergovernmental Panel on Climate
Change (IPCC) released a landmark report,
warning that humanity had a mere 12 years to radically slash
greenhouse-gas emissions or face a calamitous future in which hundreds
of millions of people worldwide would go hungry or homeless or worse.
Only 22 of the 50 biggest newspapers in the United States covered that report.

At least now they're merely ignoring it. For decades they treated the reality of climate change as a controversy, and were compelled to bring in a denier (usually secretly funded by the fossil fuel industry) as "balance" for every story. The moderators did not ask about climate change in a single presidential debate in the last 3 elections. Even as Houston and the Carolinas and Puerto Rico and the Florida panhandle were smashed by hurricanes, as the west burns and the Midwest drowns, these events are treated as isolated weather incidents.

The truth is a downer, and it's bad for ratings. But again, you are hereby commanded to read.

Update: Not only have all the dire predictions come true, it's been even worse than predicted, and sooner. That's truth, not opinion.

Sunday, April 21, 2019

The story we are about to read is not only the foundational myth of the Jewish people. It has also become a foundational myth of American Christian identity thanks to the 1956 movie starring Charlton Heston. The movie actually differs from the Biblical story in minor respects, but more important I think is that it fills in the blanks. The Biblical account is quite vague as to historical context, and offers little in the way of visual detail or specificity of action. It's mostly an outline, concerned with plot but little concerned with character. (The Torah doesn't get subjected to much literary criticism but I'm willing to go there.) The movie however has made the story vivid, and it's the version that people actually know, that fills their imaginations. So let's get started, with our critical eyes open.

Now a man of the tribe of Levi married a Levite woman,2 and she became pregnant and gave birth to a son. When she saw that he was a fine child, she hid him for three months.

Again, this is typical of the Exodus story. These people are complete blanks, we don't even know their names.

3 But when she could hide him no longer, she got a papyrus basket[a] for him and coated it with tar and pitch. Then she placed the child in it and put it among the reeds along the bank of the Nile.4 His sister stood at a distance to see what would happen to him.5 Then Pharaoh’s daughter went down to the Nile to bathe, and her attendants were walking along the riverbank. She saw the basket among the reeds and sent her female slave to get it.6 She opened it and saw the baby. He was crying, and she felt sorry for him. “This is one of the Hebrew babies,” she said.

7 Then his sister asked Pharaoh’s daughter, “Shall I go and get one of the Hebrew women to nurse the baby for you?”8 “Yes, go,” she answered. So the girl went and got the baby’s mother.9 Pharaoh’s
daughter said to her, “Take this baby and nurse him for me, and I will
pay you.” So the woman took the baby and nursed him.10 When the child grew older, she took him to Pharaoh’s daughter and he became her son. She named him Moses,[b] saying, “I drew him out of the water.”

Once again, the tale is very sketchily rendered. As Pharaoh has ordered that the male Hebrew babies be killed, why the exception? The people -- the sister, the nurse, the princess -- still have no names. Would the unnamed Pharaoh really have countenanced his (unnamed) daughter adopting a female son? In the movie, this Pharaoh's successor is named Ramses, BTW, but he has no name in the Bible. DeMille's choice was presumably made because Ramses II is the most famous Pharaoh, but he lived nearly a millennium after these events supposedly occurred. He actually conquered Canaan BTW, and that real historical event could conceivably have influenced the concept of the Egyptian captivity. However, it did not happen in Egypt.

11 One day, after Moses had grown up, he went out to where his own people were and watched them at their hard labor. He saw an Egyptian beating a Hebrew, one of his own people.12 Looking this way and that and seeing no one, he killed the Egyptian and hid him in the sand.13

Moses is a bad-ass for sure. The Egyptian is presumably armed.

The next day he went out and saw two Hebrews fighting. He asked the one in the wrong, “Why are you hitting your fellow Hebrew?”14 The man said, “Who made you ruler and judge over us?
Are you thinking of killing me as you killed the Egyptian?” Then Moses
was afraid and thought, “What I did must have become known.”15 When Pharaoh heard of this, he tried to kill Moses, but Moses fled from Pharaoh and went to live in Midian, where he sat down by a well.16

Midian, as you may recall, was a son of Abraham and the Midianites are mentioned several times in the Torah. They are named as the people who bought Joseph from his brothers. (At other points it was the Ishmaelites. Whatever.) And they will come up again. However, there is no historical evidence for their existence. Scholars do not know where Midian was or who they were. In the movie, they worship the God of Abraham, BTW, but in this account we learn almost nothing about them.

Now a priest of Midian had seven daughters, and they came to draw water and fill the troughs to water their father’s flock.17 Some shepherds came along and drove them away, but Moses got up and came to their rescue and watered their flock.

Again, bad-ass Moses overcomes several shepherds. But why didn't they want the women to water their flocks?

18 When the girls returned to Reuel their father, he asked them, “Why have you returned so early today?”19 They answered, “An Egyptian rescued us from the shepherds. He even drew water for us and watered the flock.”20 “And where is he?” Reuel asked his daughters. “Why did you leave him? Invite him to have something to eat.”

This is pretty strange because as you will see next week the guy's name is not actually Reuel, it's Jethro. Midianites, Ishmaelites; Reuel, Jethro; Jacob, Israel. Whatev.

21 Moses agreed to stay with the man, who gave his daughter Zipporah to Moses in marriage.22 Zipporah gave birth to a son, and Moses named him Gershom,[c] saying, “I have become a foreigner in a foreign land.”23 During that long period, the king of Egypt died. The Israelites groaned in their slavery and cried out, and their cry for help because of their slavery went up to God.24 God heard their groaning and he remembered his covenant with Abraham, with Isaac and with Jacob.25 So God looked on the Israelites and was concerned about them.

So God apparently had forgotten all about it for a while but now he remembers the covenant. Remember he's all powerful -- he set this whole thing up on purpose. Or maybe not? I'm confused.

Saturday, April 20, 2019

Last year I posted about Duh Sawx while they were steamrolling their way to the MLB championship. I reflected on the whole concept of fan loyalty and the seemingly irrational but culturally universal way that people live vicariously through their sports heroes. This year, mysteriously, despite bringing back pretty much the same team that flattened the competition last year, they are an abomination. I mean totally unwatchable. Can't hit, can't pitch, they stand around in the outfield watching balls bounce over the fence, they're listless and boneheaded.

There is a lot of psychology in sports. You'll notice that the most expert commentators, people who have played the game, but a lot of stock in teams' emotional state, their interpersonal chemistry (which can be all business, they don't have to like each other off the field), who is fired up for revenge on whom. It's tough to repeat, that's all there is to it. Winning a championship is often bad news for next year.

Turning now to Tiger Woods, yes what he has done is incredible. He destroyed his family because he let fame and fortune go to his head in all the wrong ways, and he overstressed his body till it gave out on him. Three years ago he was addicted to painkillers and he couldn't walk. Throughout it all -- ten years of struggle during which he could not compete -- he kept insisting that he was going to come back. And quite a lot of people, including me, though we had our doubts, thought he would probably do it. Yep.

He changed the game. Before Tiger, golfers were overweight, out of shape, smoking cigarettes between shots. He approached the game as an athlete, bulking up his shoulders and arms and hitting the ball farther than anyone before. It didn't even matter that he missed the fairway half the time because he was so close to the greens. So the young guys started going to the gym, the PGA moved the tees back, and now Tiger's length off the tee is about average. So he has to win a different way. I have to give him all the credit for fighting through terrible pain, conquering his demons, working with iron discipline and not giving up on himself. He hasn't just come back as an athlete, he genuinely seems to be a more mature, nicer person.

But we musn't forget that he is also extremely wealthy. Almost no-one in his situation can afford the very best orthopedists and surgeons and pain specialists and physical therapists and psychological counselors -- a lot of stuff insurance won't pay for. I'm pretty sure insurance would not have paid for those three surgeries. He had the resources heA needed to accomplish his miracle. Most people don't.

Also too: Let me once again remind you that "anonymous" is not an acceptable handle for commenting here. An observation about sexual misconduct by Bill Clinton was perfectly appropriate on my post about reality and the law, and I would have published it otherwise.

Clinton was impeached for lying about a blow job. Most people think that was not warranted, but his behavior was certainly scurrilous. Monica Lewinsky initiated the affair, but no, the CEO cannot have an affair with an intern. He was absolutely obliged to turn her down, and regardless of who made the first move, he was exploiting and harming a vulnerable young person. The most serious public allegation against him was by Juanita Broaddrick, who alleges that he raped her when he was Attorney General of Arkansas. There is corroboration from friends who say she told them about it at the time. She says he apologized years later, saying he was not the man he used to be. She did not go to the police and there was no investigation at the time.

So what should we make of this? I would say it is unfortunate that he was nominated and became president. I think we should have done better. Fortunately, his time as an important public figure is pretty much over. He has said and done so many idiotic things in recent years that nobody wants to be on the stage with him. And the cultural reassessment we have undergone about the sort of behavior that once got him characterized as a "charming rogue" means he's pretty much toxic anyway. He certainly didn't do his wife any good during her presidential campaign. The past can't be undone but we can do better from now on.

Tuesday, April 16, 2019

The roof and spire of Notre Dame, which was completely incinerated in
Monday's fire, were made of ancient oak. There were 13,000 beams in the
church's ceiling, and Guerry said about 3,000 trees would be needed to
replace them.

"In the Middle Ages… it was possible to find huge amounts of
beautiful strong oak," but overuse of the material led to the
destruction of many of Europe's oak forests, Guerry said. "The ability
to find around 3,000 more big, strong trees in the next two decades is
going to be tricky." But Guerry said the very tall, old trees
needed for the project might exist in the Baltic, where most of Europe's
oak comes from today.

So we're going to cut down the last of the old growth forest in Europe to please God.

As the Miami Herald reported at the time of the mass arrests in south Florida for prostitution, and as we acknowledged here, proving human trafficking in the case of these Chinese massage parlors is very difficult.

For law enforcement, cracking the rings that are behind the massage
parlors is challenging — and bringing trafficking charges even more
difficult —because of workers’ reluctance to testify, cultural
barriers and an international business structure that makes identifying
the masterminds next to impossible.
And so most continue to operate with minimal risk
of being shut down despite the occasional splashy police raids, such as
the ones last month that netted scores of charges against suspected
customers, including New England Patriots owner Robert Kraft. . . .

Many
of the women who wind up working in massage parlors and spas are
recruited from rural parts of China with nebulous promises of legal
employment in the United States, according to Polaris. Some are fleeing
domestic abuse, or their families are heavily in debt. Typically they
have little education. Agencies
in China arrange for them to travel to the United States on tourist
visas, and charge them thousands of dollars that many women agree to
work off rather than paying up front. They arrive in New York
City disoriented and confused and are made to become dependent on their
employers who often push them into sex work, said New York City lawyer
Amy Hsieh, with Sanctuary for Families, a social-services provider that
works with parlor employees arrested for prostitution or practicing
massages without a license.

“It’s a slow game of indentured servitude,” she said.

So the police are concentrating on prostitution and money laundering charges. The women are afraid to cooperate and the question of involuntary servitude is murky. Robert Kraft's lawyers are claiming that the DA's decision not to bring human trafficking charges invalidates the warrant that allowed for video surveillance. We'll see how the judge rules on that but obviously it's a technicality that doesn't exonerate Mr. Kraft. He's rich however and can pay expensive lawyers. That makes all the difference.

Update: For the record, I'm not acting as a juror in this instance. I wouldn't be anyway because the entire point of the post is that the prosecutors don't feel they can pursue the trafficking case. What constitutes proof beyond a reasonable doubt in a court of law, using legally admissible evidence, is not the same as what we may come by common sense to believe. In any event, Kraft is not charged with trafficking but with paying for sex. I don't know if that should be illegal in general but given the exploitive nature of this particular business, that is the approach the authorities are taking to shut it down.

I allowed a comment here by "unknown" because this appears to be a new visitor who doesn't know the rules. In the future, please adopt a unique identifier.

Regarding Bill Clinton, of course the specific conduct for which he was impeached was consensual, though highly inappropriate. Back in those days, powerful men got away with that kind of stuff, and much worse, all the time. Nowadays, a CEO who had a sexual relationship with an intern might well be fired, but the standard for presidential impeachment is a different question, as we can readily see under the current circumstances. Clinton may have had some even worse conduct in his past, though its unproven. Therefore, according to some people, I'm not allowed to speculate about it.

Sunday, April 14, 2019

At long last, we start Exodus. As I have mentioned before, scholars belief this was written during the Babylonian exile, in the 6th Century BCE, with revisions in the 5th Century. There is no historical evidence for the Egyptian captivity. The work is fiction, but it may be in some ways a response to the Babylonian exile. It is the foundational myth of the Jews, central to identity. Here we go.

These are the names of the sons of Israel who went to Egypt with Jacob, each with his family:2 Reuben, Simeon, Levi and Judah;3 Issachar, Zebulun and Benjamin;4 Dan and Naphtali; Gad and Asher.5 The descendants of Jacob numbered seventy[a] in all; Joseph was already in Egypt.6 Now Joseph and all his brothers and all that generation died,7 but the Israelites were exceedingly fruitful; they multiplied greatly, increased in numbers and became so numerous that the land was filled with them.

So the Hebrew population went from 70 to something like 1 million (Exodus 12:37) in a few hundred years.

8 Then a new king, to whom Joseph meant nothing, came to power in Egypt.9 “Look,” he said to his people, “the Israelites have become far too numerous for us.10 Come, we must deal shrewdly
with them or they will become even more numerous and, if war breaks
out, will join our enemies, fight against us and leave the country.”11 So they put slave masters over them to oppress them with forced labor, and they built Pithom and Rameses as store cities for Pharaoh.12 But the more they were oppressed, the more they multiplied and spread; so the Egyptians came to dread the Israelites13 and worked them ruthlessly.14 They made their lives bitter with harsh labor in brick and mortar and with all kinds of work in the fields; in all their harsh labor the Egyptians worked them ruthlessly.15 The king of Egypt said to the Hebrew midwives, whose names were Shiphrah and Puah,16 “When
you are helping the Hebrew women during childbirth on the delivery
stool, if you see that the baby is a boy, kill him; but if it is a girl,
let her live.”17

There are only 2 midwives producing this population explosion.

The midwives, however, feared God and did not do what the king of Egypt had told them to do; they let the boys live.18 Then the king of Egypt summoned the midwives and asked them, “Why have you done this? Why have you let the boys live?”19 The
midwives answered Pharaoh, “Hebrew women are not like Egyptian women;
they are vigorous and give birth before the midwives arrive.”20 So God was kind to the midwives and the people increased and became even more numerous.21 And because the midwives feared God, he gave them families of their own.22 Then Pharaoh gave this order to all his people: “Every Hebrew boy that is born you must throw into the Nile, but let every girl live.”

Consider how implausible this is. If the Hebrews are enslaved, they don't have any weapons and can't join Pharaoh's enemies in war. On the contrary, slave owners usually want to increase their holdings. There is no comparable historical event.

Friday, April 12, 2019

Since it is not a brief answer, rather than respond to Mr. Bachtell's question in the comments, I'll do a front page post on it. CDC provides information about complications of measles here. This applies to the United States and other wealthy countries. Measles is much more dangerous in poor countries where many children are malnourished or debilitated from chronic infections, but that's a bit off topic.

The actual death rate from measles in developed countries is about 1-2 per 1,000. However, 1 in 20 children will get pneumonia as a complication, which may require expensive treatment including mechanical ventilation. An additional 1 child in 1,000 will develop encephalitis which may lead to permanent brain damage. A rarer complication is subacute sclerosing panencephalitis which develops several years after a measles infection. It is a progressive, disabling, fatal brain disorder which occurs in something like 4-11 out of 100,000 cases of measles but may be more common in children under 2 years of age.

The National Health Service lists additional complications including damage to vision and hepatitis. Measles in pregnant women increases risk of miscarriage, stillbirth, and premature delivery. We have not had the experience of a widespread measles epidemic in the
present era in which there are more immunocompromised people in the
population due to modern treatment of autoimmune disorders, transplant
surgery, and HIV. These vulnerable people are at particular risk from those who refuse vaccination.

Most people recover from measles. It's usually a very unpleasant but self-limiting condition. Of course this results in school absenteeism, caregiver burden, and medical expenses. Serious complications are uncommon but can be very bad indeed. Given that vaccination has negligible risk and cost, there is a strong case to be made that it constitutes a social obligation, in my view.

Thursday, April 11, 2019

Someone is interested in laws regarding vaccination in the United States. There is often a tension between the liberty interest and social welfare in public health, at least from many people's perspective. It is a general principle that competent adults cannot be compelled to undergo any medical procedure against their will. Adults can decide to check out of the hospital against medical advice, or to treat their cancer with coffee enemas rather than surgery and chemotherapy, and the state does not get involved. As for people who are ruled not competent, that's a whole other discussion, but I will point out that a judge has to make the ruling; psychiatrists can't just do it by themselves.

Vaccination is a different matter for two reasons. First, we are talking for the most part about children. While laws, precedents and practices vary somewhat among the states, generally speaking parents can be compelled to allow essential medical treatment for their children, and may be prosecuted for neglect if they do not. There is ample precedent for compulsion to overrule even religious belief in this regard.

However, because not getting your children vaccinated is not under most circumstances immediately life threatening, the states do not directly compel it under normal circumstances. Rather, they require vaccination for school attendance, the rationale being more that it is about the protection of others rather than protection of the subject child. And most states allow religious and/or personal belief exemptions, which makes this more of a suggestion than a requirement. The map below is a couple of years old and some states may have changed their laws since, but it gives the general idea.